From the Guidelines
Advair (fluticasone and salmeterol) dosing for asthma should be initiated at the lowest effective dose, with a typical starting dose of Advair Diskus 100/50 (100 mcg fluticasone/50 mcg salmeterol) or Advair HFA 45/21 inhaled twice daily for adults and adolescents 12 years and older. For moderate to severe asthma, higher strengths may be prescribed: Advair Diskus 250/50 or 500/50, or Advair HFA 115/21 or 230/21, also taken twice daily 1. The medication should be used regularly even when symptoms improve, as it combines an inhaled corticosteroid (fluticasone) that reduces airway inflammation with a long-acting beta-agonist (salmeterol) that provides bronchodilation.
Key Considerations
- Patients should rinse their mouth after each use to prevent thrush, and should always have a rescue inhaler available for acute symptoms.
- Advair is not for rescue use during asthma attacks and should be part of a comprehensive asthma management plan.
- Dose adjustments should only be made under medical supervision, typically every 2-4 weeks until optimal control is achieved.
- For children 4-11 years old, only Advair Diskus 100/50 twice daily is recommended.
Stepwise Approach
The stepwise approach for managing asthma, as outlined in the Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma, should be followed, with the goal of achieving the best symptom control possible while minimizing the risks of uncontrolled asthma and the effect of asthma on the patient’s well-being 1.
Monitoring and Adjustments
Regular follow-up contact is essential to monitor asthma control and adjust treatment as needed, with a focus on stepping down medication for patients with well-controlled asthma to minimize the risks of systemic effects associated with higher doses of inhaled corticosteroids 1.
From the FDA Drug Label
Following administration of fluticasone propionate and salmeterol inhalation powder to healthy adult subjects, peak plasma concentrations of fluticasone propionate were achieved in 1 to 2 hours. In a single-dose crossover trial, a higher-than-recommended dose of fluticasone propionate and salmeterol inhalation powder was administered to 14 healthy adult subjects Two (2) inhalations of the following treatments were administered: fluticasone propionate and salmeterol inhalation powder 500 mcg/50 mcg, Peak steady-state fluticasone propionate plasma concentrations in adult subjects with asthma (N = 11) ranged from undetectable to 266 pg/mL after a 500 mcg twice-daily dose of fluticasone propionate inhalation powder using a dry powder inhaler The mean fluticasone propionate plasma concentration was 110 pg/mL.
The recommended doses of Advair (fluticasone and salmeterol) for asthma treatment are:
- Fluticasone propionate: 500 mcg twice-daily dose
- Salmeterol: 50 mcg twice-daily dose 2
From the Research
Recommended Doses of Advair for Asthma Treatment
The recommended doses of Advair (fluticasone and salmeterol) for asthma treatment are as follows:
- The Advair Diskus is available in 3 strengths of fluticasone propionate (100,250, and 500 microg) and a fixed dose (50 microg) of salmeterol 3
- For patients aged ≥ 12 years, the novel fluticasone propionate/salmeterol multidose dry powder inhaler (MDPI) (AirDuo RespiClick®) is available in low-, mid- and high-dosage formulations (55/14,113/14 and 232/14 μg, respectively) 4
- Stepping down treatment from fluticasone propionate/salmeterol 250/50 microg twice daily to a lower dose of 100/50 microg twice daily is more effective than switching to an inhaled corticosteroid alone 5
Key Considerations
- Combination treatment with both ICS and LABA provides greater asthma control than increasing the ICS dose alone, while at the same time reducing the frequency and perhaps the severity of exacerbations 3
- Salmeterol/fluticasone propionate is associated with a corticosteroid-sparing effect and is generally well tolerated in adults, adolescents and children aged 4-11 years 6
- Once-daily salmeterol/fluticasone propionate 50 microg/100 microg is an effective treatment compared with placebo, and was non-inferior to twice-daily fluticasone propionate 100 microg with respect to mean morning peak expiratory flow 7